Organization
STRAYHORN FAMILY MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYNN ROSS FNP (OWNER)
(662) 612-6411
Entity
Organization
Contact information
Practice address
3509 HIGHWAY 4 W, SARAH, MS 38665-3567
(662) 292-7651
Mailing address
3509 HIGHWAY 4 W, SARAH, MS 38665-3567
(662) 612-6411
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04733217
—
MS
Enumeration date
03/11/2019
Last updated
10/09/2019
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